DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20184160

Comparative study of nitroglycerin dermal patch versus nifedipine in the management of preterm labour

Manjeet Kaur, Bharti Goel, Jasveer Singh

Abstract


Background: The aim of present study was to compare the effect of nitroglycerin dermal patch and nifedipine for taking control of preterm labor (tocolysis) and to find the safer drug for mother and foetus.

Methods: Women with signs and symptoms of preterm labor between gestational ages 26-37 weeks were studied. These women were divided into 2 groups. Group A-50 women were prescribed nitroglycerin dermal patch and in Group B-50 women were given nifedipine. Primary outcome of the study was to delay the delivery for at least 48 hours. Secondary outcomes were gestational age at the time of delivery, prolongation of labor, effect on neonate and adverse effects.

Results: Both groups were comparable regarding cervical effacement in cm and gestational age in weeks at the time of enrollment. Gestational age at the time of delivery in weeks (p < 0.01), prolongation of pregnancy in days (p > 0.05), neonatal Apgar score at 5 minutes (p < 0.05), neonatal weight in kg (p < 0.05) and foetal outcomes were better in nifedipine group in comparison to nitroglycerin. The overall side effects were less in nifedipine group as compared to nitroglycerin group. Overall success rate was 88% with nifedipine and 76% in nitroglycerin cases.

Conclusions: Both the drugs were able to postpone the delivery for 48 hours. Nifedipine was found to be superior to nitroglycerin dermal patch in prolongation of gestational age at the time of delivery, in perinatal outcome and maternal acceptance.


Keywords


Gestational age, Nifedipine, Nitroglycerin, Preterm labor, Tocolysis

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References


Creasy RK: Preterm birth prevention. Where are we?. AM J Obstet Gynecol. 1993;168(4):1223-30.

Haram K, Mortensen JH, Morrison JC. Tocolysis for acute preterm labor: does anything work. J Matern Fetal Neonatal Med. 2015;28(4):371-8.

Robertson RM and Robertson D: Drugs used for the treatment of myocardial ischemia. In: Joel GH, Alfred Goodman Gilman, Lees EL (eds), Goodman and Gilman’s the pharmacological basis of therapeutics. 9th edition, McGraw Hill. 1996; pp759-779.

Jeyabalan A, Caritis SN. Pharmacologic inhibition of preterm labor. Clin obstet Gynecol. 2002;45(1):99-113.

Duckitt K, Thornton S. Nitric oxide donors for the treatment of preterm labour. Cochrane Database Syst Rev. 2002;3(3):CD002860.

Conde-Agudelo A, Romero R. Transdermal nitroglycerin for the treatment of preterm labor: a systematic review and metaanalysis. Am J of Obstet Gynecol. 2013;209(6):551-e1.

Katz B, Rosenberg A, Frishman WH. Controlled-release drug delivery systems in cardiovascular medicine. Am Heart J. 1995;129(2):359-68.

Trapani A, Gonçalves LF, Pires MD. Transdermal nitroglycerin in patients with severe pre‐eclampsia with placental insufficiency: effect on uterine, umbilical and fetal middle cerebral artery resistance indices. Ultrasound Obstet Gynecol. 2011;38(4):389-94.

Cacciatore B, Halmesmäki E, Kaaja R, Teramo K, Ylikorkala O. Effects of transdermal nitroglycerin on impedance to flow in the uterine, umbilical, and fetal middle cerebral arteries in pregnancies complicated by preeclampsia and intrauterine growth retardation. 1998;179(1):140-5.

Papatsonis DN, Van Geijn HP, Ader HJ, Lange FM, Bleker OP, Dekker GA. Nifedipine and ritodrine in the management of preterm labor: a randomized multicenter trial. Obstet Gynecol. 1997;90(2):230-4.

Read MD, Wellby DE. The use of a calcium antagonist (nifedipine) to suppress preterm labour. BJOG 1986 ;93(9):933-7.

Ulmsten U, Andersson KE, Wingerup L. Treatment of premature labor with the calcium antagonist nifedipine. Arch Gynecol.1980;229(1):1-5.

Glock JL, Morales WJ. Efficacy and safety of nifedipine versus magnesium sulfate in the management of preterm labor: a randomized study. Am J of Obstet Gynecol. 1993;169(9):960-4.

King JF, Flenady V, Papatsonis D, Dekker G, Carbonne B. Calcium channel blockers for inhibiting preterm labour; a systematic review of the evidence and a protocol for administration of nifedipine. Aust NZ J of Obstet Gynaecol. 2003;43(3):192-8.

Kupferminc M, Lessing JB, Yaron Y, Peyser MR. Nifedipine versus ritodrine for suppression of preterm labour. BJOG 1993;100(12):1090-4.

Haram K, Mortensen JH, Morrison JC. Tocolysis for acute preterm labor: does anything work. J Matern Fetal Neonatal Med. 2015 ;28(4):371-8

Ghomian N, Vahedalain SH, Tavassoli F, Pourhoseini SA, Heydari ST. et al. Transdermal Nitroglycerin Versus Oral Nifedipine for Suppression of Preterm Labor, Shiraz E-Med J. 2015 ;16(11-12):e59923.

Kashanian M, Zamen Z, Sheikhansari N. Comparison between nitroglycerin dermal patch and nifedipine for treatment of preterm labor: a randomized clinical trial. J Perinatol. 2014; 34(9):683-7.

Dhawle A, Kalra J, Bagga R, Aggarwal N. Nifedipine versus nitroglycerin for acute tocolysis in preterm labour: a randomised controlled trial. Int J of Reprod Contracept Obstet Gynecol. 2016;2(1):61-6.

Zulfiqar S, Zulfiqar S, Khan SM. Comparsion of nitroglycerine patch and nifedipine in treatment of preterm labour. JSZMC. 2016;7(2):965-7.